A Spectrum of Transitions in I/DD

Alya Reeve, MD, MPH

DDMI-TUG

11-10-14

Overview

• Definition

• Daily Transitions

• Interpersonal

• Personal Care

• Endings

• Grief/Loss

• Leaving/arriving

• Why are transitions hard?

• Importance of transition

• Transition Skills

• Conclusion

Transition

• noun: • A passing from one condition, form, stage, activity, place, etc. to

another; • A word, phrase, sentence, or group of sentences that relates a

preceding topic to a succeeding one to that smoothly connects parts of a speech or piece of writing;

• (Music)- a shifting from one key to another; modulation; an abrupt change into a remote key; a passage connecting two sections of a composition.

DAILY TRANSITIONS

• Waking from sleep • Dressing/changing clothes • Home Community • Transportation Destination • Meals • Evening activities • Weekdays vs Weekend-days • Falling to sleep

INTERPERSONAL transitions

• Greeting(s) • New people & functions

• Family members • Staff; professionals • Community-based

• Safety / Trust • Friendship • Intimate partners

PERSONAL CARE

• Layers of protection = clothes

• Vulnerability • Need for assistance

• Temperature

• Touch

• Speed

ENDINGS {complement Beginnings}

• Absence of beloved • Notice of a change

• Switching • Attachment

• Allegiance

• Process of letting go • Less emotional investment is easier

• Risking NEW attachment(s)

GRIEF/LOSS

• Loss of emotionally meaningful relationship • Impermanence • Energy drain

• Cognition

• Sleep

• Sadness

• lability

• Catastrophization (is this a word?)

LEAVING/ARRIVING

• Introductions / Make time for leave-taking

• Respect for autonomy • Prior experiences

• Provide opportunity for trust

• Adapt to individual rates/preferences

• Assist in bridging to next supports

WHY ARE TRANSITIONS HARD?

• Element of RISK • Meaning of change • Novelty • Physiologic arousal • Past experience(s)

• Positive? … Negative?...

• Ability to evaluate (observing self)

IMPORTANCE OF TRANSITION

• Services provision

• Aging process • Birth Death [applies to everyone]

• Build in skills [Infancy – Adult]

• Expand opportunities [Teen – Mid-adult]

• Losses in flexibility/relationships [Adult – Elder]

• Basic survival skill

TRANSITION SKILLS

• Identify situation

• Reduce to elements of manageable size

• Pace change when possible

• Articulate steps (repeatedly if needed)

• Everyone is affected • Share your own experience with honesty and constraint

• Provide emotional space for adaptation & expression of conflicting emotions

CONCLUSIONS

• Transitions happen all the time • Life transitions are stressful and can be handled artfully. • Support resiliency & recovery

• Attitude

• Creative solution building

• Maintain respect for individual experiences • Shared experience & support makes the psychological process easier for

everyone

Thoughts, Comments, Experiences…

Thank you for your attention & participation!